urine culture1.pdf

8/17/2019 Urine culture1.pdf

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Lab Dept: Microbiology/Virology

Test Name: URINE CULTURE

General Information

Lab Order Codes: UC

Synonyms: Culture, Urine

CPT Codes: 87088 – Culture, bacterial; with isolation and presumptive identificationof isolates, urine

The following testing may be added if appropriate based on findings fororganism identification (multiple additions are possible if more than oneorganism is identified) and to aid in patient treatment management.

87077 – Aerobic isolate, additional methods required for definitiveidentification, each isolate (if appropriate)87106 – Culture, fungi, definitive identification, each organism, yeast (ifappropriate)87107 – Culture, mold, definitive identification, each organism, mold (ifappropriate)87206 – Smear, primary source with interpretation, fluorescent and/oracid fast stain for bacteria, fungi or cell types (if appropriate)87184 – Susceptibility studies, disk method, per plate (if appropriate)87186 – Susceptibility studies, microdilution or agar dilution, each multi-antimicrobial, per plate (if appropriate)

Test Includes: Culture of aerobic flora from 1000 to >100,000 organisms/mL. Colonycounts between 100 and >100,000 organisms/mL will be performed oncystostomy, intraoperative, nephrostomy, suprapubic, and vesicostomyspecimens.

If anaerobes are suspected, an anaerobic culture must be orderedseparately. Refer to Anaerobic Culture.

Logistics

Lab Testing Sections: Microbiology

MIN Lab: 612-813-5866Phone Numbers:

STP Lab: 651-220-6555

Test Availability: Daily, 24 hours

Turnaround Time: Preliminary report available at 1 day, final report within 2 - 5 days.

http://www.childrensmn.org/Manuals/Lab/MicroBioViral/033054.asphttp://www.childrensmn.org/Manuals/Lab/MicroBioViral/033054.asp


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Special Instructions: ● Specimen site and date/time of collection are required forspecimen processing.● If anaerobes are suspected, obtain a suprapubic aspirate.

Specimen

Specimen Type: Urine

Container: Sterile container. If anaerobes are suspected, use an anaerobictransport system (available in Microbiology).

Volume: 1 mL – 10 mL of urine from a first morning specimen

Collection: Catheterized specimen:

Straight Catheter, Female:

1. Place the infant supine, with the thighs in a frog-leg position.2. Separate the labia and cleanse the area around the meatus withpovidone-iodine swabs. Use anterior-to-posterior strokes to preventfecal contamination. Rinse area with sterile water using cotton balls orsponges.3. Aseptically insert catheter into the bladder.4. Allow about 10 mL to pass, then collect 1 - 10 mL into sterile tube, orsterile container.5. After urine is collected, pull catheter out of the cap of the centrifugetube, tighten cap (and depress spout, if using the kit).

Straight Catheter, Male:

1. Place the infant supine, legs extended.2. Cleanse the penis with povidone iodine swabs in a spiral motion frommeatus outward, one sponge per stroke. Rinse area with sterile water.3. Aseptically insert catheter, holding the penis perpendicular to thebody to straighten the urethra.4. Allow about 10 mL to pass, then collect 1 - 10 mL into sterile tube, orspecimen container.5. After urine is collected, pull catheter out of the cap of the centrifugetube, tighten cap (and depress spout, if using the container).

Vesicostomy:

1. Gather supplies (lubricant, sterile gloves, sterile specimen container,and appropriate catheter).2. Don sterile gloves.3. Swab stoma site with povidone iodine.4. Open catheter. Any catheter is appropriate to use, including a sterileself cath, or a foley cath. The catheter should be larger than what wouldbe placed in the urethra (10-16Fr.) Lubricate tip.5. Insert only 1-2 inches, until you see urine. Collect/transfer into sterilespecimen container. You may need to leave catheter in place for a few


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minutes, as urine normally dribbles out slowly.

Indwelling cathether:

1. Do not collect urine from drainage bag.2. Disinfect catheter collection port with 70% alcohol.

3. Use a syringe to aseptically collect 1 - 10 mL of urine and transferinto a sterile container.

Clean catch, Mid stream Specimen:

Males:

1. Clean glans with soap and water.2. Rinse area with wet gauze pads.3. While holding foreskin retracted, begin voiding.4. After several mL have passed, collect midstream portion withoutstopping flow of urine.

5. Transfer specimen to a leak proof sterile container.

Females:

1. Thoroughly clean urethral area with soap and water.2. Rinse area with wet gauze pads.3. While holding labia apart, begin voiding.4. After several mL have passed, collect midstream portion withoutstopping flow of urine.5. Transfer specimen to a sterile leak proof container.

Bagged Specimen: (Caution: contamination rates may run as high as70%):

1. Clean glans or urethral area with soap and water.2. Rinse area with wet sponges.3. Place sterile urine bag over labia or penis.4. After 30 minutes, observe for presence of urine. If no urine ispresent, reclean patient and attach a new bag.5. If impossible to obtain urine or if culture results yield a mixture oforganisms, collect a catheterized specimen or collect urine bysuprapubic aspiration.

Suprapubic Aspiration:

1. Expose area above pubis.2. Scrub area with povidone iodine. Allow to dry.3. Using a sterile needle and syringe, aspirate 1 mL of urine frombladder.4. Transfer into a sterile container. If anaerobic culture is desired, expelair bubbles and inject urine into an anaerobic transport device.

Transport/Storage: Onsite collections: Transport to the laboratory immediately.


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If specimens cannot be processed within one hour of collection,specimens can be refrigerated up to 24 hours.

Offsite collections: Refrigerate specimen if Gray Boric acid tubecannot be immediately filled or if culture cannot be inoculated

immediately.

Gray Boric acid tube: (Available from Materials Item# 24063)Fill with urine, shake vigorously.Note: Gray top minimum fill is 3.5 mL.Store and transport at room temperature.

Plated specimens: If urine culture plating is done onsite, store inincubator and transport without coolant.

Specimens must be promptly transported to the laboratory, with thenext available courier, not to exceed 24 hours from the time of

collection. However, delayed transport causes a delay of test results.

Sample Rejection: Unrefrigerated/unpreserved specimen with a transit time exceeding 1hour after collection; improperly labeled specimen; specimens withprolonged transit time (see Transport/Storage for requirements);specimen not submitted in appropriate transport container; insufficientvolume; external contamination. If an unacceptable specimen isreceived, the physician or nursing station will be notified and anotherspecimen will be requested before the specimen is discarded.

Interpretive

Reference Range: No growth

Alert Value: ● Gram-negative rods identified as ESBL or Carbapenemase producerswill be called to the physician or patient’s nurse. Infection Preventionwill be notified.● If MRSA is isolated for the first time, and the patient location is notEmergency department, the result will be called to the physician orpatient’s nurse.

Limitations: Clean catch or catheterized specimens are not acceptable for anaerobicculture. Anaerobic organisms inhabit the anterior urethra. The onlysatisfactory urine specimen for anaerobes is a suprapubic aspirate.

Methodology: Quantitative culture

Additional Information: Although bag collection of urine from children has the advantage ofbeing noninvasive, contamination associated with this collection methodincreases the chances of adverse clinical outcomes. The contaminationrates may run as high as 70%. Researchers have concluded that therisks of bag urine cultures “appear to exceed its benefits”. Journal ofPediatrics 2000; 137:221 - 226.


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Cook, JH, and M Pezzlo (1992). Specimen receipt and accessioning.Section 1. Aerobic bacteriology, 1.2.1-4. In HD Isenberg (ed) ClinicalMicrobiology Procedures Handbook. American Society for Microbiology,Washington DC

Miller, J Michael (1999) A Guide To Specimen Management in ClinicalMicrobiology, American Society for Microbiology, Washington DC

References:

Miller, J Michael, and HT Holmes (1999) Specimen Collection,Transport, and Storage In PR Murray et al, (ed), Manual of ClinicalMicrobiology, 7

th edition, American Society for Microbiology,

Washington DC, pp 33-104

Updates: 3/22/2010: CPT updates11/30/2011: Added information regarding anaerobes.6/20/2012: Addition of Alert Value11/18/2013: Transport/Storage time increased from 12 to 24 hours.11/20/2014: Offsite information added.

7/16/2015: Vesicostomy collection instructions updated.

urine culture1.pdf

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